ISV - USA Application - November

International Student Volunteers
2009-10 USA PARTICIPANT APPLICATION - NOVEMBER - JANUARY PROGRAM
Please use your full legal name that will appear on passport


Last Name		First Name		Middle Name		Nickname


Number & Street (current address)	City State/Territory	Zip Code	Country


Number & Street (mailing/permanent)	City State/Territory	Zip Code	Country

			Male	Female
Mobile Phone	Email	Age


Home Phone	Alternate Email	Date of Birth


Country of Birth	Country of Residence	Citizenship


Emergency Contact Name 1		Relationship		Mobile Phone		Email Address


Emergency Contact Name 2		Relationship		Mobile Phone		Email Address

			Freshman			Junior	Graduate Student
University (if applicable)		University Major	Sophmore			Senior
				T-shirts Size:	S M L XL

Do you have any physical disabilities?	Yes	No
Do you take any prescribed medications?	Yes	No
Do you have any special dietary needs?	Yes	No
Do you have any allergies?	Yes	No
Are you a returning ISV participant? (If yes, what country & Year?)	Yes	No

PROJECT PREFERENCE: Check the boxes that apply below. Remember, the more flexible you are, the easier it will be for ISV to reserve a place for you. (Your actual project will be assigned one month prior to departure to your host country.)

I would like to participate in a conservation project (New Zealand, Costa Rica, Thailand, South Africa)

I would like to participate in a community development project (Costa Rica, South Africa, Thailand)

I am willing to do anything and have no project preference.

Please state the full name of any friend you would like to be placed with, as well as the name of the University
they attend. (if applicable)

HOST COUNTRY: In the spaces provided, number each country in order of preference ("1" is your first country preference). Then, check all the departure dates on which you are available to travel in each program during November 2009 to February 2010. Remember, the more flexible you are the easier it will be for ISV to reserve a place for you.

*All participants travelling to Costa Rica will be automatically enrolled for the Spanish Lesson Option and these departure dates reflect the date you need to depart to undertake this. If you specifically do not wish to participate in the Spanish Lesson Option, you will be given the option to “opt out” of this at the time of signing your agreement. Your departure date will be one week later.


Costa Rica	Thailand	South Africa	New Zealand
16 Nov 2009	23 Nov 2009	02 Dec 2009	10 Jan 2010
30 Nov 2009	07 Dec 2009	13 Jan 2010
28 Dec 2009	04 Jan 2010	27 Jan 2010
11 Jan 2010	18 Jan 2010

	Why would you be a suitable participant on ISV's programs?

	Date university classes end for second semester		Date university classes begin for first semester

	Hobbies/interests: (Please list activities/interests you enjoy most)

	Travel experience: (Please list all foreign countries to which you have travelled)

Do you speak Spanish?

Beginner

Intermediate

Advanced

Fluent

How did you find out about the ISV Summer Program?
Flyer	E-mail	Website	STA Website
Classroom Announcement	Name of Announcer	Other	Other Description
ISV Rep	Name of Rep

		I am interested in earning Academic Credit for details, go to our website www.isvonline.org. Note: Students are responsible for determing in advance the transferability of units to their home institutions. There will be an additional cost for Academic Credit.

		I am interested in receiving information about how I can raise funds from the community to offset the cost of the ISV program

LIABILITY AGREEMENT: I VERIFY THAT ALL THE ABOVE INFORMATION IS CORRECT; I FURTHER AGREE TO ABIDE BY ALL THE LAWS OF THE COUNTRY I WILL BE VISITING INCLUDING, BUT NOT LIMITED TO, REFRAINING FROM ANY USE OF ILLEGAL DRUGS. I REALIZE THAT ISV REQUIRES EACH PARTICIPANT TO HAVE HIS/HER OWN TRAVEL/MEDICAL INSURANCE WHICH WILL COVER THE PARTICIPANT WHILE IN THE COUNTRY OF TRAVEL AND AGREE TO SECURE SUCH INSURANCE PRIOR TO MY DEPARTURE TO MY FOREIGN COUNTRY. I HAVE READ, UNDERSTAND, AND AGREE TO ABIDE BY ALL THE POLICIES STATED IN ISV'S TERMS & CONDITIONS.


	Your Signature		Date

				INTERNATIONAL STUDENT VOLUNTEERS, INC. 4848 Lakeview Ave. Suite 100A Yorba Linda, CA 92886 PHONE: (714) 779-7392 FAX: (714) 777-4647 EMAIL: isvusa@isvonline.org WEBSITE: www.isvonline.org